PHT_1211_L2__1_

Disabilities & Therapeutic Procedures PT 1211

• Instructor: Professor Enrique Amador

State of the Industry

• Job Market: Abundance of job opportunities with decent wages.

• Concerns:

  • Fraud and abuse in the industry - financial impact shared by all.

• Relevant Practices:

  • Evidence-Based Practice (EBP).

  • Relevant legislation: Obama's Affordable Care Act.

  • Ethical considerations during the COVID pandemic.

  • Rise of telemedicine.

Prof. Amador’s Model: Key Components

• Model Components:

  • Knowledge/Science/EBP/Art

  • Loving/Caring

  • Communication

• Importance:

  • Discuss which aspect is most critical for success.

Knowledge/Science/EBP/Art

• Application:

  • Teaching therapeutic exercises (TE’s).

  • Gait training.

  • Following safe practices in treatment.

  • Selecting appropriate physical agents/modality for specific symptoms/dysfunctions.

Loving/Caring

• Importance of Empathy:

  • Caring for patients is essential for successful treatment outcomes.

  • Mental imagery to connect with patients' experiences (pain, depression).

Communication

• Role in Treatment:

  • Establishes trust and confidence.

  • Fuels the caregiver-patient relationship.

Evidence-Based Practice (EBP)

Five Steps of EBP

1. Ask - Define the problem/question.

2. Acquire - Gather relevant information.

3. Appraise - Assess the evidence.

4. Apply - Implement findings in practice.

5. Assess - Evaluate outcomes of the applied techniques.

ART in Treatment

• Definition:

  • Achievement of treatment goals with physical agents is an intricate combination of art and science, requiring mastery.

Course Readings

• Insights From Readings:

  • Many concepts may appear intricate but are not essential for treating patients effectively.

Understanding Pain

Defining Pain

• Definition:

  • Unpleasant sensory and emotional experience indicating potential tissue damage.

Characteristics of Pain

• Aspects to Consider:

  • Sensory

  • Emotional/Subjective/Psychological

  • Tissue damage/Trauma

  • Function as a "Warning System" and implications on healing.

Sensory Aspects of Pain

• Neurological Basis:

  • Defined by afferent and efferent facets of neurology.

  • Requires understanding of:

    • Anatomy

    • Physiology

    • Nociceptors

    • Mechanoreceptors

    • Gate Control Theory.

Emotional/Subjective/Psychological Factors

• Subjectivity of Pain Perception:

  • Composed of personal and learned behaviors, affecting pain experience.

Tissue Damage Understanding

• Focus for Therapy:

  • Directly corresponds to actual or potential tissue damage.

  • Integration of art and science in treatment where scientific answers may be incomplete.

Pain as a Warning Mechanism

• Importance of Pain Understanding:

  • Examining how pain can hinder healing and recovery.

Other Pain Terms

• Definitions:

  • Hypalgesia: Diminished pain sensitivity.

  • Hyperalgesia: Increased pain sensitivity.

  • Hyperesthesia: Oversensitivity.

  • Paresthesia: Decreased sensation/numbness.

  • Analgesia: Absence of pain.

  • Anesthesia: Loss of sensation.

Acute vs Chronic Pain

Acute Pain

• Characteristics:

  • Triggered by infection, injury, or disease.

  • Clearly localized; easy to diagnose and treat.

• Patient Interaction: Generally more favorable as they often seek help due to clear issues.

Chronic Pain

• Characteristics:

  • Prolonged duration (>3 months); often diffuse/referred.

  • Causes can be ambiguous with significant psychological effects.

• Patient Interaction: Typically involves individuals seeking help with unresolved pain.

Pain Cycle Dynamics

• Understanding Interaction:

  • Relationship between pain, muscle guarding, and dysfunction.

• Cycle Overview:

  • Pain ↔ Muscle Guarding ↔ Dysfunction.

Cycle of Pain and Dysfunction

• Illustrated Cycle:

  • Factors: Anger, Frustration, Helplessness; Loss of Function; Muscle Guarding; Inflammation; Impaired Circulation.

Use of Physical Agents

• Impact on Pain Cycle:

  • Proper utilization of physical agents directly addresses pain cycle components:

    • Hot Packs alleviate pain.

    • Cold Packs reduce inflammation/pain.

    • Electrical Stimulation mitigates muscle guarding/pain.

    • Ultrasound aids in breaking adhesions and improving range of motion.

Anatomy/Physiology in Pain

• Course Integration:

  • Expansion of anatomical knowledge over time (CNS, PNS, Pain Receptors).

  • Key Concept: Gate Control Theory.

Pain Theories: Gate Control Theory

• Mechanism:

  • Pain transmission via nociceptors to spinal cord.

  • Role of T-cells in pain modulation based on various factors.

Transmission of Pain Signals

• Route of Transmission:

  • Signal travels from periphery through different anatomical structures to the cortex, emphasizing the need to manage pain effectively.

Natural Pain Killers in the Body

• Neurotransmitters:

  • Endogenous Opiates:

    • Enkephalins: Short-acting, interference at spinal cord level.

    • Endorphins: Inhibited pain transmission across the nervous system.

    • Serotonin: Unclear mechanisms but involved in pain signal modulation.

    • Dopamine: Relevant to movement regulation and potential synthesis of pain relief chemicals.

Conditions Triggering Pain Relief Chemicals

• Release Factors: Occurs during intense pain, exercise, acupuncture, laughter, meditation, relaxation.

Referred Pain

• Concept Introduction:

  • Pain perceived at a different site from its origin (localization error).

  • Example: Heart attack pain felt in the arm; lumbar disc issues reflecting as leg pain.

Dermatome Map

• Overview:

  • Shows areas affected by specific nerve roots broken down by corresponding dermatomes.

Tissue Repair Process

• Healing Stages:

  • Inflammatory Phase: Swelling; duration 1-10 days.

  • Proliferative Phase: Revascularization; duration 3-20 days.

  • Remodeling/Maturation Phase: Collagen restructuring; onset 9 days and onward.

• Documentation: Refer to properties of scar tissue, factors influencing tensile strength.

Role of PT and PTA in Healing

• Professional Responsibility:

  • Knowledge and integration of science in a logical manner to facilitate patient healing through assessment and intervention.

• Course Objective:

  • Comprehensive review to prepare students for professional excellence.

Inspirational Quote

• “The only disability in life is a bad attitude.” - Oscar Pistorius